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Monoparesis

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Abstract

The term monoparesis denotes the presence of neurological deficits in one limb. However, monoparetic animals are frequently presented to the veterinary surgeon with the main complaint being lameness. This chapter looks at clinical signs, lesion localization, pathophysiology, differential diagnosis, neurodiagnostic investigation, degenerative diseases, anomalous diseases, neoplastic diseases, inflammatory diseases, traumatic diseases, toxic diseases, vascular diseases.

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Figures

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17.1 Neurological pathways responsible for the cutaneous trunci reflex. Cutaneous stimulation along the thoracolumbar region often elicits a twitching of the skin. The twitching is due to contraction of the cutaneous trunci muscle. Illustration created by Allison L. Wright, MS, CMI, Athens, Georgia, USA.
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17.2 Lesion localization for monoparesis. Spinal cord segments C6–T2 and L4–S3 are highlighted. Illustration created by Allison L. Wright, MS, CMI, Athens, Georgia, USA.
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17.6 Peripheral nerve supply to the thoracic limb and the pelvic limb. Illustration created by Allison L. Wright, MS, CMI, Athens, Georgia, USA.
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17.7 Cutaneous autonomous zones of innervation of the thoracic limb and the pelvic limb. (Based on and , respectively). Illustration created by Allison L. Wright, MS, CMI, Athens, Georgia, USA.
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17.9 Paresis in the right pelvic limb of a German Shepherd Dog due to ipsilateral lumbosacral foraminal stenosis. (Courtesy of S Platt)
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17.10 Transverse CT image showing a foraminal disc extrusion at the C6–C7 right intervertebral foramen. (Courtesy of Dr K Vernau)
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17.11 Ventrodorsal myelogram showing an intradural–extramedullary lesion at the C6–C7 intervertebral foramen (arrowed).
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17.12 Transverse CT image showing enlargement of the ventral and dorsal nerve roots at the C6–C7 intervertebral foramen.
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17.13 Dorsal T1-weighted MR image of a peripheral nerve sheath tumour arising from the C2 nerve root following intravenous administration of contrast medium. Note the extension of the neoplasm inside the vertebral canal (arrowed) causing secondary spinal cord compression.
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17.14 Brachial plexus neuritis with bilateral nerve root swelling in a 9-year-old Burmese cat. This post-mortem specimen shows the swollen nerves (arrowed) as they exit ventrally from the intervertebral foramina (arrowheads). (Courtesy of T Scase and L Garosi)
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17.15 Brachial plexus avulsion caused by a road traffic accident in a 3-year-old male Mastiff. Note that only one limb is affected. The close-up of the affected limb demonstrates severe neurogenic atrophy.
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17.16 Brachial plexus avulsion. Excoriations are seen in the affected thoracic limb, secondary to dragging of the limb and decreased sensation.
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17.17 Sensory loss associated with brachial plexus avulsion. Shaded zones are dermatomes that lack sensation. (Based on ). Cranial plexus avulsion. Caudal plexus avulsion. Complete plexus avulsion. Illustration created by Allison L. Wright, MS, CMI, Athens, Georgia, USA.
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17.18 Sciatic nerve dysfunction in a young male Siberian Husky. There were severe conscious proprioception deficits with loss of tone in the distal limb.
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17.19 Femoral nerve dysfunction in a 9-year-old male mixed-breed dog. The inability to bear weight is profound with the affected limb carried flexed at the stifle.

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Left sciatic nerve neuropathy

This dog had a history of chronic left pelvic limb paresis that progressively worsened. Note the atrophy of all flexor muscles in the affected limb and the abnormal gait. The dogs advances the distal end of the limb passively. Patellar pseudo-hyperreflexia is also visible, as well as a decreased flexor reflex (especially hock flexion) in the affected limb. (See page 340 in the Manual)

Partial brachial plexus avulsion

The right thoracic limb monoparesis is caused by a partial brachial plexus avulsion. The dog is able to flex the elbow and advance the affected limb forward. (See page 337 in the Manual)

Peroneal nerve paralysis

The dropped hock in the affected right pelvic limb is clearly visible. The animal is unable to flex the tarsus but the remainder of the joints in the affected limb flex and extend normally. (See page 340 in the Manual)

Right brachial plexus avulsion

The right thoracic limb monoparesis is caused by a complete brachial plexus avulsion. Note the inability of the animal to extend or flex the elbow. In addition, there is an ipsilateral miotic pupil (partial Horner's syndrome) and lack of the ipsilateral cutaneous trunci flex, which indicates spinal cord damage caused by the avulsion. (See page 337 in the Manual)

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